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i <br /> 180 BLUE RAVINE ROAD, *E B <br /> AIR TOXICS LTD. FOLSOM, CA 95630-4719 <br /> (916) 985-1000 FAX (916) 985-1020 <br /> AN ENVIRONMENTAL ANALYTICAL LABORATORY {- <br /> 1 loci' r"J <br /> It <br /> CHAIN-OF-CUSTODY RECORD Page of <br /> Contact Person M ;JV a SPI S 4n <br /> Protect Info Turn Around Time <br /> Company ro,,,1 r. A c-l I-le // PO # <br />� y6 !� tc�lt'c��� ��6� ��►•��.�t� O'Narmal <br /> Address City State Zip 9f-oa Protect# f 3 ❑ Rush <br /> Phone �� _ `� ' FAX f]�Ca #Zt3 Specify <br /> Protect Name <br /> Lab Field Sample I D Date & Time Analyses Requested Canister Pressure/ Vacuum <br /> D. Initial Final Receipt <br /> i3Tx�� -- -- <br /> Collected By. Print re <br /> k Notes as r <br /> Re utshed y store Datarri Received By(Signature) Datelrime <br /> 00 <br /> Relinquished B (Signature) Datig`nme wed By (Signature) Date/Time <br /> Relinquished By (Signature) D e R 8y(Signal aime I <br /> l �- VV <br /> shipper Name Air 010# 0 fined - at+3Tftma ' Tem {°C) Gondition Cusiod Seals Intac Work Order# <br /> Lab Use l 4 AJIJ Yes Na ane _,�_U_1 kl<-�-� <br /> 6nly <br /> it <br /> ' Form 1293iev 05 <br />